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Wed Jan 4 03:16:10 GMT 2006

So from an intensivist as requested:

- I expect the anaesthetist is working hard at basic resuscitation. This includes: warm the room until the surgeon sweats, warm fluids (nothing clear - blood products only at this point), clotting factors (platelets, FFP, cryprecipitate, prothrombinex), and rVIIa before her ever got this bad. There is nothing an intensivist can add to what a good anaesthetist is already doing. 

- Please control his pulmonary bleeding promptly and get out of his chest. No clever dissections, just a tractotomy or stapled resection
- Please do as little as possible to the oesophagus - drain the proximal oesophagus and put in some medistinal drains. Come back tomorrow to do something a bit more clever such as a primary repair if feasible / sensible.
- Close his chest quickly and get OUT of the operating room

When everything has settled down tomorrow by all means go back to theatre for a second look see.

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Staff Specialist in Intensive Care Medicine
The Nepean Hospital, 
PO Box 63, Penrith NSW 2751
Clinical Lecturer, University of Sydney

>>> KMATTOX at aol.com 01/04/06 12:34pm >>>

By the time all injuries found, he had lost almost 3000 ml of blood and had  
6 units of bank blood.   BP 85/40, P 140, pH of 6.9, was getting  
coagulopathic, T 92 degrees F, and had base deficite of -24  (still).    So we have a very 
sick patient, cold, acidotic,  coagulopathic, and injury to both lungs, heart 
and  esophagus.      

>From the surgeons on this group, I need to know what you would do and in  
what order?

>From the intensivist on this group, I need to know just when and in what  
condition do you want him to be brought to you.   Should the surgeons  call you 
to the OR to aid in his management?   Maybe the OR should  become an ICU bed?   

Next installment (# 5) in 24 hours (maybe).   Remember that  tomorrow night 
at this time, Texas will be playing USC in the Rose Bowl and I  might get 
distracted.    

k
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